Physical Activity and Outcomes in Colorectal Surgery: A Pilot Prospective Cohort Study

Abstract

Background: Mobilization after surgery is recommended to reduce the risk of adverse effects and to improve recovery. The aim of this study was to examine the associations between perioperative physical activity and postoperative outcomes in colorectal surgery. Methods: The daily number of footsteps was recorded from preoperative day 5 to postoperative day 3 in a prospective cohort of patients using wrist accelerometers. Timed Up and Go Test (TUGT), 6 Min Walking Test (6MWT), and peak expiratory flow (PEF) were assessed preoperatively. ROC curves were used to assess the performance of physical activity as a diagnostic test of complications and prolonged length of stay (LOS) of more than 5 days. Results: A total of 50 patients were included. Patients with complications were significantly older (67 years) than those without complications (53 years, p = 0.020). PEF was significantly lower in the group with complications (mean flow 294.3 vs. 363.6 L/min, p = 0.038) while there was no difference between groups for the other two tests (TUGT and 6MWT). The tests had no capacity to discriminate the occurrence of complications and prolonged LOS, except the 6MWT for LOS (AUC = 0.746, p = 0.004, 95% CI: 0.604-0.889). There was no difference in the mean number of preoperative footsteps, but patients with complications walked significantly less postoperatively (mean daily footsteps 1,101 vs. 1,243, p = 0.018). Conclusions: Colorectal surgery patients with complications were elderly, had decreased PEF, and walked less postoperatively. The 6MWT could be used preoperatively to discriminate patients with potentially increased LOS and foster mobilisation strategies.

Functional outcomes following pelvic exenteration: results from a prospective cohort study

“…Furthermore, 5STS has been shown to be a reliable tool for assessing functional lower extremity strength, balance and exercise capacity [16,48,49]. Whilst there are limited studies that report outcomes of objective functional assessments in pelvic exenteration (none of which involves the use of the 6MWT or 5STS), there have been several studies on physical outcomes following abdominal surgery, with poorer outcomes of functional tests being typically associated with worse postoperative morbidity [18,37,39,50].…”

Wearable devices to monitor recovery after abdominal surgery: scoping review

“…Patients with postoperative delirium had similar mobilization in the early postoperative interval and had lower physical activity at 1 month after surgery 83 . Of these studies aiming to predict postoperative outcomes with postoperative physical activity measurements, only four accounted for patients’ baseline preoperative physical activity levels 76 , 80 , 81 , 83 . No studies analysed physical activity data in ‘real time’ to monitor recovery or identify complications.…”

“…Normalizing a patient’s postoperative physical activity relative to their baseline may be a more appropriate method for risk assessment 76 , 80 , and the characterization of mobilization ‘patterns’ as suggested by Iida et al . may offer more detailed insights into the prediction of specific postoperative complications 78 , 79 .…”

Feasibility of a prehabilitation program before major abdominal surgery: a pilot prospective study

“…The TUGT and 6-MWT were performed as previously described. 28 For handgrip dynamometry, participants stood in an upright position with their hands positioned by their sides, holding the dynamometer in the dominant hand, and squeezed for 3 seconds before relaxing (three repetitions). 15 The EORTC QLQ-C30 is an internationally validated cancer-specific questionnaire.…”